The purpose of this study is to organize and test methods to bring about a change in behavior over time, in order to achieve the main goals of increasing adherence with hand hygiene, contributing to the reduction of healthcare-associated infections (HAIs) and reducing the use of antibiotics in nursing homes.
In Norway, we lack a system to examine the hand hygiene adherence of healthcare workers in nursing homes. Although we know that residents of nursing homes are particularly vulnerable to infections and that good hand hygiene is the best single measure we have against the transmission of infections.
There is also no system for continuous monitoring of infections and antibiotic use in nursing homes, only prevalence surveys are carried out twice a year.
Therefore, this study wants to examine healthcare personnel's practice and compliance with hand hygiene. Furthermore, we will monitor infections and antibiotic use in nursing homes and investigate if there is a relationship between infections and adherence with hand hygiene.
In addition, it will test interventions to improve hand hygiene adherence over time in nursing homes.
Nursing home residents are particularly vulnerable to infectious diseases due to weaker immune systems, multiple conditions, impaired functional status, and the likelihood of using medical equipment, such as urinary tract catheters, peripheral venous catheters, and feeding tubes.
Infections acquired when receiving care is called healthcare-associated infections (HAIs). They are cause of disease, suffering, hospital admissions, and death among nursing home residents.
Many infections could have been avoided and proper hand hygiene is the single most effective preventive measure against the spread of infections. The COVID-19 pandemic showed us increased morbidity and mortality among frail nursing home residents and indicates the need to improve infection prevention in nursing homes.
The population of older people is increasing, even though the number of nursing home beds is decreasing. Care in nursing homes has become more intense and difficult, and healthcare workers experience a large workload with complex tasks.
Nursing homes are high care-requirement homes, with residents having short expected lifespans and high rates of frailty and comorbidities. Infection management in nursing homes is made more difficult by the fact that these facilities serve as both homes with personal items, and care facilities with advanced health care equipment for residents.
Infection prevention in nursing homes is therefore a significant public health concern.
More about the project
Nursing home wards in a large municipality were invited to participate in this quasi-experimental study, which will last over 18 months. At least 20 nursing home wards will be included in the study, three of which will receive interventions, while the rest will be control wards.
The interventions will be initiated and carried out by different groups in the three departments. The manager and educational nurses on one ward, healthcare workers working bedside on the other and students in collaboration with the research team on the third.
This study will use direct observations of healthcare workers in nursing homes, to measure hand hygiene practices and adherence. The observations will follow WHOs guidelines and observation form and will be carried out at the start and end of the study. Surveillance of infections and antibiotic use will be carried out by having designated healthcare workers at each ward submitting weekly reports.
After six months of collecting data on trends of infections and antibiotic use, three intervention wards will be selected based on mean values. Subsequently, multimodal interventions for improving hand hygiene adherence based on Albert Bandura’s theory in behavior change, will be implemented in the interventions wards over a period of 12 months.
The study would investigate healthcare workers practices and adherence to hand hygiene recommendations.
The effect of the interventions will be measured by comparing the intervention wards against the control wards in hand hygiene adherence, infection rates and antibiotic use during the 12 months the interventions are in progress.